ZHealth News

ZHealth Coding Newsletter - July 2017

Jul 30, 2017 2:22:00 AM

July 2017 Q & A

Question: Superior Mesenteric Artery to Rt Hepatic Artery

A 5 Fr sheath was placed and attached to a heparinized saline infusion. Exchange was made for a SOS catheter and selective DSA performed in the superior mesenteric artery. Superselective catheterization of the replaced right hepatic artery was then performed using a 3 Fr Progreat Microcatheter and wire. Can a catheter reach the right hepatic artery from the SMA or does the catheter need to go through the celiac artery?

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Posted in Free Newsletters By Sondra Dunn

January 2017 Q & A

Question: 32551 vs 32557

IR chest tube placement. 

Indication: Large symptomatic right pneumothorax status post CT-guided lung biopsy. 

Technique: The patient was placed supine on the fluoroscopy table. The right hemithorax was prepped and draped in a sterile fashion. The fifth and sixth rib interspace was localized with fluoroscopy, and 1% lidocaine was utilized for local anesthesia. A Cook pneumothorax 9 French drainage catheter was placed into the right pleural space using a trocar under direct fluoroscopic surveillance. The drain was then connected to a Heimlich valve, and good reexpansion of the right lung was achieved after the patient coughed. Postprocedural images demonstrate a small residual right apical pneumothorax with the drainage catheter overlying the anterior midlung zone. 

Impression: Successful placement of 9 French chest tube with satisfactory re-expansion of the right lung.

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - April 2016

Apr 25, 2016 2:20:00 PM

April 2016 Q & A

Question: Popliteal Aneurysm

We are looking for a code for popliteal aneurysm (37236?). This is what one of our physicians said: "34900 code is an aneurysm procedure code, and although specifies iliac it is far more reflective of the procedure type and work, including large sheath placement that is involved with popliteal aneurysm repair. In fact the 2 procedures are almost identical except one is done at a more distal location." What code do you suggest we use for popliteal aneurysm and why?

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Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - March 2016

Mar 30, 2016 2:20:00 PM

March 2016 Q & A

Question: Angioplasty or Primary Thrombectomy with No Stenosis Documented

Patient is on Day 2 of lower extremity arterial thrombolysis with EKOS catheter. The patient was placed on the angio table and the catheter was injected showing significant residual heavy clot burden. The physician ballooned the thrombus in the anterior tibial, posterior tibial and peroneal arteries with a 3mm balloon, then used an aspiration catheter in each vessel post ballooning due to loose clot seen within these vessels. There is no physician documentation of any underlying anatomical stenosis in these vessels. Thrombolysis was restarted with the EKOS catheter and sent to the floor for overnight monitoring. On Day 3, the patient is brought back for AngioJet thrombectomy, repeat ballooning of the peroneal along with thrombolytic spray through the AngioJet for 20 min. This is repeated in the posterior tibial artery. Follow-up angiography demonstrates a flow limiting dissection requiring stent placement.

Day 2 was coded as ...

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Posted in Free Newsletters By Sondra Dunn

February 2016 Q & A

Question: Vasospasm

Six vessel diagnostic cerebral exam performed. Decision made to treat vasospasm of RICA & LICA. Discussion is whether or not the catheter selections for the bilateral ECA vessel selections are still chargeable since the catheter selections of the RICA & LICA are bundled into 61650. I don't feel they are since they are add on codes to 36224, bilateral in this case.
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Posted in Free Newsletters By Sondra Dunn

October 2015 Q & A

Question: When do you use 75630 vs 75625

I am completely confused on Abdominal Aortic imaging. Does CPT code 75625 require 2 catheter placements or not? For example, physician places a catheter in the abdominal aorta near the renal arteries and performs abdominal aortography, also documents bilateral pelvic and common femoral artery imaging. The physician then moves the catheter to the SFA and completes the angiography with chase bolus runoff to the foot on the left. Is this coded as 36247, 75625, 75716 or is it 36247, 75630?

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Posted in Free Newsletters By Sondra Dunn

September 2015 Q & A

Question: 36228 with Pipeline Embolization

Following diagnostic cerebral angiogram with bilateral internal carotid artery catheter and 3D angiogram requiring separate work station, angle projections for treatment of the cavernous segment of the right internal carotid artery aneurysm were obtained. Navien catheter was positioned within the intracranial segment of the right internal carotid artery, and Marksman catheter was navigated into the right middle cerebral artery. Then pipeline embolization was done on the right cavernous carotid segment. At the completion of the coiling procedure, cerebral angiogram was performed via the right internal carotid artery. Besides 36224-50, can I add 36228 in this case even though the embolization was at cavernous carotid? I also coded 61624, 75894, 75898, and 76377. Are these the right codes for this case?

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Posted in Free Newsletters By Sondra Dunn

New C-code Effective April 1st (C2623)

Mar 18, 2015 3:51:48 PM

New HCPCS code C2623, Catheter, transluminal angioplasty, drug-coated, non-laser, will be effective April 1, 2015.

Code C2623 is a “pass-through” code and will receive additional payment from Medicare when billed. Hospital charge description masters should be updated with this code on April 1, 2015. These catheters can cost over $2,000, so it is important for the facility to receive the additional reimbursement when these specialty catheters are used.

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Posted in News By Sondra Dunn

December 2014 Q & A

Question: Preoperative Tumor Embolization

The preoperative embolizations are sometimes confusing because they are done for varying reasons. When embolization is arteries supplying tumor, would this be considered Tumor Embolization? Patient has metastatic renal cell carcinoma to femur.

 

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Posted in Free Newsletters By Sondra Dunn

November 2014 Q & A

Question: IVUS Without A Base Code

I thought I read something about a change regarding IVUS without a base code. The patient has known CAD, and the only procedure done was an IVUS of the Left Main and LAD. Patient's groin prepped, 5 French sheath was placed and the guide was advanced. Wire was placed down to the LAD & IVUS of Left Main and LAD was done. I have documentation of the IVUS findings. Catheter as well as sheath were removed. IVUS would be coded as 92978 &92979, but current edits indicate a base code is needed. We don't have a base code. Was there a change so this can be coded, or is there another code that we should add, or is our claim going to be denied?

 

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Posted in Free Newsletters By Sondra Dunn

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